How Can This Be a Safe Discharge?

This morning I was working on discharge planning with one of our case managers. A doctor was ready to discharge a patient and she had asked me for recommendations. I immediately said SNF. He wasn't able to safely transfer out of bed. I had yet to see him walk due to complaints of back pain. And he lacks insight into his limitations. The case manager agreed with me but said the patient was refusing to go anywhere but home.

Believe me, this is not someone who needs to go home. He can't make it to the bathroom without assist. I don't know how he would function if he were home alone. On top of that he has a 10-step entry into his home. Finally the case manager called the man's wife. After some hemming and hawing, she stated the patient's brother had recently moved in and would be able to assist her with assisting him.

Both the case manager and I know that isn't going to work. His family isn't going to be able to manage him. The case manager informed me his insurance won't pay our facility if we say he needs to go to a SNF and he goes home. The only way we'll be reimbursed is if he follows whatever discharge plan we establish.

I get that is a problem. What I don't understand is when did we stop billing these people? Who decided and when that patients are no longer responsible for medical bills? Maybe the question is when did people stop caring whether medical bills were paid? Once again, we have decisions being made based on reimbursement that aren't in the best interest of the patient.

Both the case manager and I documented our concerns. She added a statement that his wife states she and his brother will be able to adequately care for him 24/7. Both of us know that isn't correct but there's nothing we can do about it. It'll only be a matter of time until he is readmitted, probably worse than he already is. How is this good patient care? How is this good discharge planning?

The saddest part of this is that it's not an isolated case. It goes on every day where I work and in facilities throughout the country. These people are in and out of the same facilities over and over again. Eventually the insurance companies will refuse to pay us because of multiple admissions for the same problem.

1 comments

I'm not clear as to why the patient's refusal to go to an SNF would affect the payment for your facility. I worked for a managed care company back in the USA and never heard of a requirement like that.

It seems to me that your facility is being punished unfairly by the insurance company.

You're absolutely right, this is no way to run a business nor a way to provide appropriate patient care. Facilities need to step up and confront insurers who have ludicrous rules. Is there an insurance board or ombudsman in TX that can help? It seems like the facility is opting for the path of least resistance but in so doing, tacitly gives consent for the insurance company to continue this practice.

Dean Metz

July 30, 2014 2:22 PM

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